Intersectional Identities and Worker Experiences in Home Health Care: The National Home Health Aide Survey

Abstract

As the population ages in the United States and globally, health-care demands are rising and varied, including the growth of home health care. Small, regional, qualitative studies indicate both satisfaction and exploitation in home health-care work. These intimate, caring relationships with clients may be especially challenging for minorities due to client prejudice and structural marginalization. This study broadens the scope of current research by addressing issues facing home health-care workers using large-scale, nationwide data. Using nationally representative data of home health aides in the US, the National Home Health Aide Survey (NHHAS), we evaluate which features of work are related to overall satisfaction. The prevalence and sources of discrimination and working conditions are examined according to workers’ intersectional gender, race, ethnicity, and class identities. Satisfaction was highest for those who were extremely satisfied with challenging work, learning new skills, and were most supported in their caring labor. Salary was the area with the most frequent dissatisfaction. Support for reproductive and caring labor was often inadequate. Black women and men reported the highest levels of discrimination (about 28.0%), followed by Hispanic women and men (16.5% and 10%, respectively). The largest source of discrimination was patients (80.4%). There were differences in job outcomes according to intersectional identities of race, class, and gender. Discrimination, low wages, and not having enough support for both reproductive and caring labor are problems for home health aides. Improving home health aide work is also likely to improve patient outcomes.